Dermatologic surgery
An evolving paradigm for the workup and management of high-risk cutaneous squamous cell carcinoma

Presented at the 2012 American College of Mohs Surgery Annual Meeting, Chicago, IL, May 2012.
https://doi.org/10.1016/j.jaad.2013.05.011Get rights and content

Background

No established standard of care exists for aggressive cutaneous squamous cell carcinoma (CSCC).

Objective

We sought to establish an aggressive CSCC management protocol by reviewing high-risk CSCC (HCSCC) and very high-risk CSCC (VCSCC) cases at our institution.

Methods

This was a retrospective review of all CSCC cases treated at our institution.

Results

A total of 27 patients were identified of 1591 cases treated between 2000 and 2011. Four patients with HCSCC received surgery alone and 1 received surgery and radiation. All remain disease free (median follow-up 5 years). Among patients with VCSCC, 4 received surgery alone: 1 (25%) showing a complete response and 3 (75%) showing disease progression. Eleven received surgery and radiation: 4 (36.4%) with complete response (median follow-up 3 years) and 7 (63.6%) with disease progression (median time to recurrence 6 months). Six received surgery and cetuximab: 3 (50%) had a complete response (median follow-up 3 years), 2 (33%) had disease progression, and 1 (14%) could not be assessed because of inability to tolerate infusions. One patient received surgery, cetuximab, and radiation, and remains disease-free after 4 years.

Limitations

Lack of randomization, blinding, a true control arm, or standardization of treatment protocols are limitations.

Conclusions

Patients with very HCSCC may have improved outcomes with surgery and adjuvant cetuximab.

Section snippets

Methods

The study design was approved by the institutional review board at Columbia University Medical Center, New York, NY. A retrospective chart review was performed on cases of HCSCC and VCSCC identified among patients seen in the Mohs micrographic surgical division at Columbia University Medical Center between 2000 and 2011. HCSCC was defined as a tumor possessing 3 or more high-risk features on initial clinical and histologic evaluation, including location on the head and neck, size greater than

Results

In all, 1591 cases of CSCC were treated between 2000 and 2012. A total of 27 patients with HCSCC or VCSCC were identified and included in the study (Table I; available at http://www.jaad.org).

Five qualified as having HCSCC: 4 were treated with surgery, and 1 with surgery and adjuvant radiation. All remain disease-free with no evidence of progression or recurrence, with a median follow-up of 5 years.

In all, 22 patients with VCSCC were identified. Four were treated with surgery alone. In this

Discussion

When evaluating a patient with CSCC, there are many risk factors to consider that might increase the likelihood of recurrence or metastasis. Many studies and published guidelines attempt to clarify these characteristics, which include: diameter greater than 2 cm; thickness greater than 2 mm; Clark level greater than IV (invasion into subcutaneous fat); perineural invasion (sometimes limited to “large caliber”); degree of histologic differentiation; host immunosuppression; recurrence; growth in

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  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

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